MEDICARE: AT HOME VISITING PHYSICIANS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1881945640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT HOME VISITING PHYSICIANS, INC.

Provider Business Mailing Address
First Line	:	9101 NIGHTINGALE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2713
Country	:	US
Telephone Number	:	817-297-0447
Fax Number	:

Provider Business Practice Location Address
First Line	:	9101 NIGHTINGALE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2713
Country	:	US
Telephone Number	:	817-297-0447
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MS. GRACE A EBAN
Credential	:
Telephone Number	:	817-297-0447

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	09/19/2012

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